A Comparative Study of Probiotic Lactic Acid Bacilli alone and in Combination with Bifidobacterium and Saccharomyces as Adjuvants to ORS and Zinc in the Management of Acute Pediatric Diarrhoea
Introduction: Pediatric diarrhoea is the second leading cause of childhood mortality. It is a major global health problem, particularly affecting children under the age of 5 years. It is managed with oral rehydration salt, and zinc supplements. Recently, there has been a trend of prescribing probiotics which help in reducing the frequency and duration of diarrhoea. As India is fast emerging as a potential market for probiotics, scientific studies are required to ensure their efficacy. With this background, this study was undertaken to evaluate the role of probiotics in the treatment of acute onset mild and moderate pediatric diarrhea.
Materials and Methods: This was an observational, prospective, open label, comparative study. It was conducted on 90 children after obtaining informed consent from their guardian. The participants were allocated to one of three study groups as follows; Group A: ORS & zinc Group, B: ORS, Zinc and lactic acid bacilli; Group C: ORS, Zinc and combination of lactic acid bacilli acidophilus, Bifidobacterium lactis and Saccharomyces boulardii. They were followed up for 72 hours after receiving the treatment and after 7 days. The outcome measures were reduction in mean duration and mean frequency of diarrhea. Data was collected in case report forms. Statistical analysis was done using ANOVA followed by Dunnet’s test.
Results: The mean frequency of diarrhea on day 1 in Group A, B and C were 5.87±1.23; 6.5±1.15 and 6.63±1.42 respectively. On day 2, in Group A it was 2.93±0.82; Group B, 3.23±0.99 and in Group C, 2.73±0.89 respectively. On day 3, in Group A it was 1.33±0.47; Group B, 0.86±0.5 and in Group C, 0.53±0.5 respectively. The mean duration of diarrhea in Group A, B and C were 4.5±0.76, 3.47±0.5 and 3.17±0.37 days respectively. There was significant reduction in mean frequency and duration of diarrhea in Group B and C compared to Group A (p˂0.05).
Conclusion: Probiotics when used alone or in combination as adjuvant to ORS and Zinc in the treatment of acute pediatric diarrhea results in significant reduction in mean frequency and mean duration of diarrhea.
2. Banerjee B, Hazra S, Bandyopadhyay D. Diarrhea management among under fives. Indian J Ped. 2004;41:255-260.
3. Faure C. Role of antidiarrheal drugs as adjunctive therapies for acute diarrhea in children. International J Ped. 2013; :1-14.
4. Basu S, Paul DK, Ganguly S, et al. “Efficacy of high-dose lactobacillus rhamnosus GG in controlling acute watery diarrhea in Indian children: A randomized controlled trial.” J Clin Gastroenterol. 2009;43(3):208-13.
5. Bhatnagar S, Bhandari N, Bhan M K. Consensus statement of IAP national task force: status report on management of acute diarrhea. Indian J Ped. 2004; 41: 335-348.
6. Dixit G, Samarth D, “Comparative studies on potential Probiotic characteristics of Lactobacillus acidophilus strains” Eur Asian J of BioSciences 2013; 7: 1-9.
7. Vandenplas Y, Huys G, Daube G. “Probiotics an update” Journal de pediatria 2015;l (91): 6-21.
8. De vrese M, Marteau P R, “Probiotics and Prebiotics: Effects on diarrhea” J.Nutr.march 2007;137:S-811.
9. Mattia A, Merker R “Regulation of Probiotic Substances as Ingredients in Foods: Premarket Approval or Generally Recognized as Safe Notification” Clin Infect Dis. 2008;46: S115-S118.
10. Sharma K A, Mohan P, Nayak B B., “ Probiotics: making a comeback” Ind J Pharmac;2005;37(6):358-365.
11. Applegate J A, Fischer walker J L “Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children” BMC public health.2013;13(3):S16.
12. Guandalini S, Pensabene L, Zikri M A, Dias J A, Casali L G., et al. “lactobacillus GG administered in Oral rehydration solution to children with acute diarrhea.” J of Ped Gastroenterology and nutrition 2000;30(1):54-60.
13. Khanna V, Alam S, Malik A, Malik A. “Efficacy of tyndalized lactobacillus acidophilus in acute diarrhea.” Ind J of ped 2005;72: 935-938.
14. Grandy G, Medina M, Soria R, Teran C G and Araya M. “ Probitics in the treatment of acute rotavirus diarrhea.” A randomized, double-blind, controlled trial using two different probiotic preparations in bolivian children. BMC infectious diseases 2010: 253-261.
15. Duggan C, Lasche J, McCarty M, Mitchell K, Dershewitz R, Lerman S J, et al., “Oral rehydration solution for acute diarrhea prevents subsequent unscheduled follow-up visits.” Pediatrics 1999;104(3):e29.
16. Ganguly NK, Bhattacharya SK, Sesikeran B, Nair GB, Ramakrishna BS, Sachdev HPS, et al.,. ICMR-DBT guidelines for evaluation of Probiotics in food. Ind J Med Res. 2011; 134(1): 22–25.